Comparison of the Analgesic Effects of Ultrasound Guided Supra-Inguinal Fascia Iliaca Block with Femoral Nerve Block for Surgical Fixation of Hip Fractures

Introduction: Regional anaesthesia techniques have been used for perioperative analgesia for hip fractures. The supra-inguinal approach to fascia iliaca block (FIB) can potentially provide superior analgesia compared to femoral nerve block (FNB) by blocking the obturator and lateral femoral cutaneous nerves. We aimed to evaluate the analgesic effect of single shot FIB and FNB for surgical fixation of hip fractures. Methods: After obtaining ethics approval and written, informed consent, 30 patients undergoing surgical fixation of hip fractures were recruited and randomized into 2 groups. Patients received either a single shot FIB or FNB with 0.5% Ropivacaine 30 mls, and a subarachnoid block. Pain scores were assessed pre-operatively, post-block, in recovery and at 24 hours post-operatively. Time to first analgesic, oxynorm consumption, opioid related side effects and block related complications were assessed at 24 hours. Results: There were no statistically significant difference in post-block pain scores, median (IQR) of 0 (0 - 0) versus 0 (0 - 0) at rest and 3 (2 - 6) versus 5 (2 - 6) on positioning for spinal;and 24 hour pain scores were 0 (0 - 0) versus 0 (0 - 0) at rest and 4 (2 - 5) versus 5 (2 - 6) on movement for FIB and FNB groups respectively. 5 patients from each group required post-operative opioids, post-operative opioids requirement were similar. Conclusions: Though ultrasound guided supra-inguinal FIB was more consistent in blocking the lateral femoral cutaneous nerve then a femoral nerve block, this did not translate to any difference in terms of pain scores, opioid consumption and side effects.

Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture

BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.

Ultrasound-guided fascia iliaca compartment block combined with general anesthesia for amputation in an acute myocardial infarction patient after percutaneous coronary intervention: A case report

BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique that is easy to implement.Here,we report a case of fascia iliaca compartment block in a patient with myocardial infarction who underwent emergency middle thigh amputation.CASE SUMMARY A 78-year-old female patient weighing 38 kg with gangrene and occlusive peripheral atherosclerosis of the right leg underwent an emergency middle thigh amputation.The patient had a history of hypertension,coronary heart disease,cerebral infarction,anterior wall myocardial infarction,and had recently undergone percutaneous coronary intervention consisting of coronary angiography and right coronary artery stent implantation.Considering the patient's condition,an ultrasound-guided fascia iliaca compartment block combined with general anesthesia was implemented for amputation.The fascia iliaca compartment block provided analgesia for the operation,and reduced the dosage of general anesthetics.It also alleviated adverse cardiovascular effects caused by pain stress,and ensured the safety of the patient during the perioperative period.This block also provided postoperative analgesia.The patient had a good prognosis,and was subsequently discharged from hospital.CONCLUSION Fascia iliaca compartment block provides surgical analgesia.It also alleviates adverse cardiovascular effects,and ensures patient safety during the perioperative period.

Ultrasound-guided,direct suprainguinal injection for fascia iliaca block for total hip arthroplasty:A retrospective study

BACKGROUND Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients undergoing total hip arthroplasty.AIM To investigate whether ultrasound-guided,direct suprainguinal injection for fascia iliaca block accelerated recovery after general anesthesia and relieved postoperative pain after total hip arthroplasty.METHODS Patients who underwent total hip arthroplasty under general anesthesia in 2015 or 2019 at The Second Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.The patients were grouped based on whether preoperative suprainguinal fascia iliaca block was performed or not.The time to tracheal extubation and time spent in the post-anesthesia care unit(PACU),intraoperative remifentanil dosage,fentanyl consumption in the PACU,postoperative cumulative fentanyl consumption within 48 h after operation,visual analogue scale at rest and during movement on the first and second days after surgery,and adverse reactions were compared.RESULTS Thirty-one elderly patients who underwent total hip arthroplasty were included in the study(block group,n=16;no-block group,n=15).The visual analog scale scores at rest and during movement on the first and second days were significantly lower in the block group than in the no-block group(all P<0.05).Compared with the no-block group,the intraoperative remifentanil dosage was lower,the time to tracheal extubation and the time spent in the PACU were shorter in the block group(all P<0.01).Fentanyl consumption in the PACU and postoperative cumulative fentanyl consumption in 48 h after operation were lower in the block group(all P<0.01).The incidence of dizziness was higher in the no-block group than in the block group(P=0.037).CONCLUSION Ultrasound-guided,direct suprainguinal injection for fascia iliaca block led to faster recovery after general anesthesia and early postoperative pain relief in elderly patients undergoing total hip arthroplasty.

Combined fascia iliaca compartment block and monitored anesthesia care for geriatric patients with hip fracture: Two case reports

BACKGROUND Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.CASE SUMMARY This report established that hip surgical procedures can be performed with a fascia iliaca compartment block(FICB)and monitored anesthesia care(MAC)while avoiding neuraxial or general anesthesia.This was a preliminary experience with two geriatric patients with hip fracture,American Society of Anesthesiologists status III,and with many comorbidities.Neither patient could be operated on within 48 h after admission.Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications.Hence,we chose nerve block combined with a small amount of sedation.Intraoperative analgesia was provided by single-injection ultrasound-guided FICB.Light intravenous sedation was added.Surgical exposure was satisfactory,and neither patient complained of any symptoms during the procedure.CONCLUSION This report showed that hip surgery for geriatric patients can be performed with FICB and MAC,although complications and contraindications are common.The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.

The Impact of Adding Magnesium Sulfate to Bupivacaine versus Bupivacaine Alone in Fascia Iliaca Compartment Block in Burn Patients Undergoing Skin Grafting Procedures;Comparative Study

Purpose: The purpose of the study is to evaluate the analgesic effect of adding magnesium sulfate to bupivacaine in Fascia Iliaca Compartment Block (FI-CB). Patients and Methods: Ninety-six burn patients scheduled for skin-grafting procedures were allocated into two equal groups. After induction of general anaethesia, forty-eight patients received US guided FICB using 35 ml bupivacaine 0.25% + 5 ml isotonic sodium chloride solution with a total volume of 40 ml. The other forty-eight patients received 35 ml bupivacaine 0.25% + 250 mg of magnesium sulfate with a total volume of 40 ml. Results: Total postoperative pethidine consumption in the first 24 h post-operative showed a highly statistically significant decrease in the magnesium group in comparison to the bupivacaine group. Conclusion: Adding magnesium sulfate to bupivacaine in FICB in skin grafting procedures decreased the pain scores post-operative, delayed the first request of analgesia and reduced the total analgesic consumption in the first 24 h post-operative without any significant side effects.

Effect of fascia iliaca compartment block combined with general anesthesia on the pain and inflammatory stress mediator secretion after hip replacement

Objective:To investigate the effect of fascia iliaca compartment block combined with general anesthesia on the pain and inflammatory stress mediator secretion after hip replacement. Methods: A total of 170 patients with femoral neck fracture who underwent hip replacement in this hospital between September 2015 and August 2017 were divided into the control group (n=103) who underwent routine general anesthesia and the study group (n=67) who underwent fascia iliaca compartment block combined with general anesthesia after the anesthetic solutions were reviewed. The differences in serum contents of pain mediators, inflammatory factors and stress hormones were compared between the two groups of patients immediately after surgery as well as 12 h and 24 h after surgery.Results: Immediately after surgery, there was no statistically significant difference in serum contents of pain mediators, inflammatory factors and stress hormones between the two groups. 12 h and 24 h after surgery, serum pain mediators NPY, PGE2, 5-HT,β-EP and SP contents of study group were lower than those of control group;serum inflammatory factors CRP, TNF-α and IL-1β contents were lower than those of control group;serum stress hormones Cor, CA and ACTH contents were lower than those of control group.Conclusion: fascia iliaca compartment block combined with general anesthesia can effectively reduce the postoperative pain as well as the systemic inflammatory response and stress response induced by pain in patients with hip replacement.

Effect of ropivacaine fascia iliaca compartment block combined with dezocine multimodal analgesia on the pain and stress response after hip replacement

Objective: To study the effect of ropivacaine fascia iliaca compartment block combined with dezocine multimodal analgesia on the pain and stress response after hip replacement. Methods: A total of 74 cases of elderly patients who received hip replacement in Mianyang Central Hospital between December 2015 and June 2017 were selected and randomly divided into multimodal analgesia group (MMA group), and patient-controlled intravenous analgesia group (PCIA group), MMA received ropivacaine fascia iliaca compartment block, dezocine preemptive analgesia combined with patient-controlled intravenous analgesia, and PCAI group received patient-controlled intravenous analgesia. The levels of pain-related molecules and stress-related hormones in serum as well as the levels of stress-related immune molecules in peripheral blood were detected immediately after surgery and 12 h after surgery. Results: 12 h after surgery, serum SP, PGE2, TNF-α, IL-1β, IL-10, FC, NE, E and GH levels and peripheral blood Foxp3+ cell fluorescence intensity of both groups of patients were significantly higher than those immediately after surgery, peripheral blood CD3+, CD4+, CD8+ cell fluorescence intensity were significantly lower than those immediately after surgery, serum SP, PGE2, TNF-α, IL-1β, IL-10, FC, NE, E and GH levels and peripheral blood Foxp3+ cell fluorescence intensity of MMA group 12 h after surgery were significantly lower than those of PCIA group, and peripheral blood CD3+, CD4+, CD8+ cell fluorescence intensity were significantly higher than those of PCIA group. Conclusion: Ropivacaine fascia iliaca compartment block combined with dezocine multimodal analgesia can reduce the pain and stress response after hip replacement.

髋关节囊周围神经阻滞与髂筋膜间隙阻滞对老年股骨粗隆间骨折患者镇痛效果的对比研究

目的 探讨髋关节囊周围神经(pericapsular nerve group, PENG)阻滞与髂筋膜间隙阻滞(fascia iliaca compartment block, FICB)对老年股骨粗隆间骨折(intertrochanteric femur fracture, IFF)患者股骨近端防旋髓内钉(proximal femoral nail anti-rotation, PFNA)内固定术的镇痛效果。方法 选取2022年1—12月首都医科大学附属北京积水潭医院老年IFF患者60例,随机分为P组和F组,每组各30例。P组采用PENG阻滞,F组采用FICB。两组患者均接受椎管内麻醉进行手术,术后均给予患者静脉自控镇痛(patient controlled intravenous analgesia, PCIA)。比较两组患者不同时点(T1,神经阻滞前;T2,神经阻滞后30 min;T3,术后6 h;T4,术后24 h;T5,术后48 h)静息和运动时的视觉模拟评分(visual analogue score, VAS)、术后补救镇痛率、镇痛满意度评分、住院时间、PCIA按压次数及不良反应发生率。结果 60例患者中,男23例,女37例,年龄65~85岁,平均(70.6±6.0)岁。两组T2~T5时点静息和运动时VAS均低于T1时点,差异均有统计学意义(P <0.05);两组静息和运动时所有时点VAS、术后补救镇痛率、镇痛满意度评分、住院时间、PCIA按压次数及不良反应发生率的比较,差异均无统计学意义(P>0.05)。结论 PENG阻滞与FICB均可缓解老年IFF患者PFNA内固定术的镇痛,且镇痛效果相当。

超声引导下髋关节囊周围神经阻滞与髂筋膜间隙阻滞对老年髋部骨折术后疼痛及恢复影响

目的探讨超声引导下髋关节囊周围神经阻滞(PENGB)与髂筋膜间隙阻滞(FICB)对老年髋部骨折术后疼痛及恢复的影响。方法选取秦皇岛市第一医院自2019年4月至2023年12月收治的80例老年髋部骨折患者为研究对象,按照随机数字表法分为FICB组与PENGB组,每组各40例。患者均接受手术治疗,FICB组在全身麻醉诱导前超声引导下行FICB,PENGB组在全身麻醉诱导前超声引导下行PENGB。比较两组的视觉模拟量表(VAS)评分,感觉阻滞有效率,术中丙泊酚和瑞芬太尼用量,简易智力状态检查量表(MMSE)评分,不良反应发生率,以及术后1个月的认知功能障碍发生率。结果PENGB组术后6、12、24 h的静息状态下和运动状态下VAS评分均低于FICB组,差异有统计学意义(P<0.05);两组术后48 h的静息状态下和运动状态下VAS评分比较,差异均无统计学意义(P>0.05)。PENGB组术后6、12、24 h的感觉阻滞有效率均高于FICB组,差异有统计学意义(P<0.05);两组术后48 h的感觉阻滞有效率比较,差异无统计学意义(P>0.05)。两组术中丙泊酚用量比较,差异无统计学意义(P>0.05);PENGB组术中瑞芬太尼用量少于FICB组,差异有统计学意义(P<0.05)。两组术前12 h、术后24 h的MMSE评分比较,差异均无统计学意义(P>0.05);PENGB组术后48、72 h的MMSE评分均高于FICB组,差异有统计学意义(P<0.05)。两组不良反应发生率和认知功能障碍发生率比较,差异均无统计学意义(P>0.05)。结论与全身麻醉复合超声引导下采用FICB比较,采用PENGB在老年髋部骨折术中可取得更好的镇痛效果,术中麻醉药物用量更小,更利于患者术后认知功能恢复。

超声引导下腹股沟上髂筋膜阻滞对游离股前外侧皮瓣修复术后早期恢复质量的影响

目的探讨术前超声引导下腹股沟上髂筋膜阻滞对四肢毁损伤患者游离股前外侧皮瓣修复术后早期疼痛及恢复质量的影响。方法选择因四肢毁损伤择期行游离股前外侧皮瓣修复术的患者79例,男47例,女32例,年龄18~60岁,BMI 16~28 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:超声引导下腹股沟上髂筋膜阻滞组(F组,n=39)和对照组(C组,n=40)。F组在麻醉诱导前行超声引导下腹股沟上髂筋膜阻滞,注射0.375%罗哌卡因和地塞米松5 mg混合液共30 ml;C组不行神经阻滞,所有患者全麻用药方案相同。记录术中丙泊酚、瑞芬太尼、舒芬太尼、血管活性药物用量、拔管时间、PACU停留时间;出PACU时、术后2、6、12、24、48 h静息时NRS疼痛评分;术后第1、2天镇痛泵有效按压次数及补救镇痛情况;术前、术后第1、2天15项恢复质量量表(QoR-15)评分;术后48 h内不良反应(头晕、恶心呕吐、皮肤瘙痒、呼吸抑制、低氧血症等)发生情况;出院时皮瓣供区伤口愈合、受区存活情况及住院时间。结果与C组比较,F组术中瑞芬太尼、舒芬太尼用量及使用血管活性药的例数明显降低,拔管时间、PACU停留时间明显缩短(P<0.05);术后2、6 h静息时NRS疼痛评分和术后第1天镇痛泵有效按压次数、补救镇痛率均明显降低(P<0.05);术后第1、2天的QoR-15评分均明显提高(P<0.05);术后48 h内头晕、恶心呕吐的发生率明显降低(P<0.05)。两组术中丙泊酚用量,出PACU时、术后12、24、48 h静息时NRS疼痛评分,术后第2天镇痛泵有效按压次数及补救镇痛率,术后皮肤瘙痒、呼吸抑制、低氧血症发生率,皮瓣供区愈合率、受区存活率及住院时间差异均无统计学意义。结论超声引导腹股沟上髂筋膜阻滞应用于游离股前外侧皮瓣修复四肢毁损伤可减少围术期镇痛药用量,缩短麻醉复苏时间,缓解术后早期疼痛,减少术后不良反应发生,提高术后早期恢复质量。

超声引导“领结征”髂筋膜阻滞技术在髋关节术后镇痛中的应用效果观察

目的观察超声引导“领结征”髂筋膜阻滞技术在髋关节术后镇痛中的应用效果。方法招募2020年1月至2023年5月于铜陵市人民医院择期行全髋关节置换术或人工股骨头置换术治疗的髋骨骨折患者60例,采用随机数字表法将其分为对照组和观察组,每组30例。对照组接受术后静脉镇痛,观察组在对照组镇痛方案基础上行超声引导“领结征”髂筋膜阻滞技术。比较两组术后阿片类药物用量、离床时间、住院时间、出院时Harris评分。比较两组术后2 h(T_(0))、6 h(T_(1))、12 h(T_(2))、24 h(T_(3))和48 h(T_(4))被动视觉模拟量表(PVAS)评分和主动视觉模拟量表(IVAS)评分。比较两组睡眠满意度、镇痛满意度及术后并发症发生率。结果与对照组相比,观察组术后48 h内追加阿片类药物剂量更少,离床时间更早,住院时间更短,出院时Harris评分更高,差异有统计学意义(P<0.05)。两组术后PVAS评分、IVAS评分呈下降趋势,且观察组下降幅度更大(P<0.05)。在T_(1)~T_(4)时间点,观察组的PVAS评分、IVAS评分显著低于对照组(P<0.05)。观察组术后24 h、48 h的睡眠质量满意率高于对照组,术后镇痛总体满意率高于对照组,差异有统计学意义(P<0.05)。两组术后并发症总发生率比较差异无统计学意义(P>0.05)。结论超声引导“领结征”髂筋膜阻滞技术可在髋关节术后中取得较好的镇痛效果,减少阿片类药物使用量,提高患者术后睡眠质量,有利于患者术后康复。

超声引导下连续髂筋膜间隙阻滞超前镇痛在老年股骨颈骨折患者中的应用

目的:探讨超声引导下连续髂筋膜间隙阻滞(UCFICB)在老年股骨颈骨折患者行超前镇痛的舒适度和有效性,并从相关应激炎症因子血清白介素-6(IL-6)和脑源性神经营养因子(BDNF)角度客观评价其效果。方法:选择赣州市人民医院2022年1—12月全身麻醉下行单侧全髋关节置换术患者60例,采用随机数字表法将患者分为两组:试验组(n=30,入院后行超声引导下连续髂筋膜间隙阻滞超前镇痛)和对照组(n=30,常规静脉自控镇痛)。比较两组患者不同时间点疼痛感受、精神状况、外周血IL-6和BDNF水平,以及术中阿片类药物消耗情况。结果:两组入院即刻静息状态下和运动时的视觉模拟评分法(VAS)评分比较,差异均无统计学意义(P>0.05);术后24、48 h,与对照组相比,试验组静息和运动状态下VAS评分均低,差异均有统计学意义(P<0.05)。试验组手术中舒芬太尼、瑞芬太尼消耗总量均少于对照组,差异均有统计学意义(P<0.05)。两组入院时的简易精神状态评价量表(MMSE)评分差异无统计学意义(P>0.05);术后24、72 h,试验组MMSE评分均高于对照组,差异均有统计学意义(P<0.05)。与对照组相比,试验组术毕、术后24 h的IL-6水平均较低,BDNF水平均较高,差异均有统计学意义(P<0.05)。结论:超声引导下连续髂筋膜间隙阻滞超前镇痛应用于老年股骨颈骨折患者,能够缓解围手术期疼痛,减少镇痛药物的使用,降低围手术期炎症应激反应,改善患者认知。

IPB复合全麻对髋关节置换术患者围术期镇痛效果及术后股四头肌肌力的影响

目的:探讨髋关节置换术中行髂腰肌平面阻滞(IPB)复合全麻的围术期镇痛效果及其对患者术后股四头肌肌力的影响。方法:将98例行髋关节置换术的患者按照接受麻醉方案不同分为对照组与观察组,每组各49例。全麻诱导前,观察组行IPB;对照组行髂筋膜间隙阻滞(FICB),两组均予以0.375%罗哌卡因30 mL注射。术毕均行静脉自控镇痛。记录两组术后2、6、12及24 h静息和活动时疼痛评分;记录并比较两组术中麻醉药物使用量、术后镇痛情况;记录两组患者术后2、6、24及48 h股四头肌肌力评分;记录两组术后恢复情况和不良反应发生情况。结果:两组术后2~24 h的VAS评分(静息、活动时)、术中麻醉药物用量、补救镇痛率及镇痛泵按压次数无统计学差异(P>0.05)。较于对照组,观察组术后2~24 h股四头肌肌力均更高(P<0.05)。与对照组相比,观察组下床活动更早(P<0.05),首次步行距离更长(P<0.05),术后住院时间更短(P<0.05)。两组不良反应总发生率无统计学差异(P>0.05)。结论:在全麻髋关节置换术中,IPB可为患者提供良好镇痛,且较于FICB,保留了股四头肌肌力,利于患者术后快速恢复。

超声引导下髂筋膜联合坐骨神经阻滞对下肢血运重建患者术后主要心血管不良事件的影响

目的评价超声引导下髂筋膜联合坐骨神经阻滞对下肢ASO患者血运重建术后主要心血管不良事件和预后的影响。方法选择性下肢血运重建手术ASO患者353例。根据术中采取不同的麻醉方式将患者分为两组:超声引导下髂筋膜联合坐骨神经阻滞组(B组)和手术监测麻醉(MAC)(M组);主要观察指标:ASO患者行下肢血运重建术后的主要心血管不良事件(MACE)发生率。次要观察指标:非心脏术后心肌损伤(MINS)、术后截肢、其他不良反应(如术后谵妄、恶心呕吐等)的发生率、术后实验室指标。通过倾向性得分匹配平衡术前基线,对匹配后的数据分析不同麻醉方式对下肢ASO患者血运重建术后MACE和预后的影响。结果在倾向性得分匹配后,与M组相比,B组的MACE发生率更低(10%vs.3.4%,P=0.038);B组的MINS发生率(33%vs.25%,P=0.200);B组的截肢率(4.2%vs.3.4%,P>0.99);B组的并发症发生率为(6.8%vs.4.2%,P=0.39);两组术后实验室指标差异无统计学意义(P>0.05)。多因素分析显示神经阻滞(OR=0.25,95%CI:0.05~0.93)、术后HBG(OR=0.95,95%CI:0.91~0.99)是降低MACE发生的保护。结论超声引导下髂筋膜联合坐骨神经阻滞可以降低下肢ASO患者血运重建术后发生MACE的风险。

右美托咪定联合髋关节囊周围神经阻滞在老年髋关节置换术中的麻醉效果

目的 探究右美托咪定联合罗哌卡因神经阻滞用于老年直接前方入路髋关节置换术(DAA-THA)的麻醉效果,并比较髋关节囊周围神经阻滞(PENGB)和腹股沟韧带上髂筋膜间隙阻滞(S-FICB)的镇痛效果及快速康复的影响。方法 选取2022年2~10月安徽医科大学附属六安医院择期下行单侧全髋关节置换术的患者90例,采用随机数字表法分为3组:A组(S-FICB组,n=30),单独使用罗哌卡因;B组(PENGB组,n=30),单独使用罗哌卡因;C组(PENGB组,n=30),使用右美托咪定联合罗哌卡因。记录患者入室时(T_(0))、体位摆放前即刻(T_(1))、体位摆放时(T_(2))静息时VAS疼痛评分和神经阻滞后6 h(T_(3))、12 h(T_(4))、24 h(T_(5))、48 h(T_(6))抬髋15°时VAS疼痛评分,神经阻滞后T_(3)~T_(6)的Ramsay镇静评分,T_(3)时股四头肌肌力分级,神经阻滞的操作时间和起效时间,患者镇痛满意度,术中血流动力学指标,不良反应的发生率,术后首次下床时间和术后住院天数。结果 T_(3)时B组和C组的股四头肌肌力明显高于A组(P<0.01)。T_(3)~T_(6)时C组的Ramsay镇静评分高于A组和B组(P<0.05)。T_(2)时B组和C组的VAS疼痛评分低于A组(P<0.05)。T_(4)~T_(6)时C组的VAS疼痛评分明显低于A组和B组(P<0.01)。B组、C组的操作时间低于A组(P<0.05)。C组患者麻醉后30 min的心率低于A组和B组(P<0.05)。结论 PENGB操作所需时间短、起效快,并且保留股四头肌的运动功能,右美托咪定作为佐剂联合罗哌卡因用于PENGB能够有效延长镇痛时间,为患者提供良好的术后镇静与镇痛,且无明显不良反应,有利于患者术后早期康复。

超声引导下腹股沟韧带上髂筋膜间隙阻滞在老年髋部骨折患者围术期镇痛中的应用研究

目的髋部骨折患者围术期易出现剧烈疼痛,既往很多研究主要关注患者术后镇痛,而很少有人探究老年髋部骨折患者在术前使用髂筋膜间隙阻滞技术的镇痛效果。本研究拟分析超声引导下腹股沟韧带上髂筋膜间隙阻滞在老年髋部骨折患者围术期镇痛中的应用价值。方法选取2023年1月—2023年12月于复旦大学附属金山医院骨科就诊的老年髋部骨折患者80例,按照随机数字表法将其分为观察组(n=40)和对照组(n=40)。观察组采用超声引导下腹股沟韧带上髂筋膜间隙阻滞(suprainguinal fascia iliaca compartment block,S-FICB),对照组采用静脉注射帕瑞昔布钠常规镇痛。2组均进行术前镇痛。记录患者实施镇痛前即刻(T0)、镇痛后30 min(T1)和2 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)的疼痛评分(VAS评分)、Ramsay镇静评分、平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO_(2))。比较2组追加静脉注射帕瑞昔布钠的例数。比较2组恶心呕吐、嗜睡、尿潴留、低血压等不良反应的发生例数及术前满意度、住院时间的情况。结果2组VAS评分除T0时间点外,其余时间点对照组VAS评分较观察组高(P<0.05)。在T2、T3时间点,观察组较对照组Ramsay镇静评分高(P<0.05)。2组MAP、HR、SpO_(2)比较,差异无统计学意义(均P>0.05)。在行镇痛治疗后,观察组较对照组追加帕瑞昔布钠例数少(P<0.05)。对照组较观察组恶心呕吐发生率多(P<0.05)。观察组患者术前满意度较对照组高(P<0.05)。2组住院时间相比之下并无显著差异(P>0.05)。结论超声引导下腹股沟韧带上髂筋膜间隙阻滞(S-FICB)在老年髋部骨折患者的围术期镇痛效果显著,能够有效缓解术前疼痛,减少全身止痛药物的用量,降低恶心呕吐发生率,提高患者术前满意度。

不同神经阻滞技术对全髋关节置换术患者术后镇痛效果及髋部运动的影响比较

目的:探讨髂腰肌平面阻滞(IPB)与髂筋膜间隙阻滞(FICB)对全髋关节置换术(THA)患者术后镇痛效果及髋部运动的影响。方法:将2022年1月—2023年12月在福州市第一总医院行THA的96例患者随机分为对照组与观察组,每组48例。麻醉诱导前,对照组行FICB,观察组行IPB,两组术后均予以静脉镇痛。记录两组神经阻滞操作时间和术中麻醉药物使用情况;于术后2、6、12和24 h,对患者疼痛评分分别进行记录;对两组术后24 h内镇痛情况进行记录;记录两组患者术后24 h内股四头肌肌无力发生情况;此外,记录两组术后恢复情况。结果:较于对照组,观察组神经阻滞操作时间更短(P<0.05),两组术中丙泊酚和瑞芬太尼用量差异均无统计学意义(P>0.05)。两组术后2、6、12和24 h各时间点疼痛评分、术后24 h内镇痛泵按压次数、舒芬太尼用量及补救镇痛率对比差异均无统计学意义(P>0.05)。较于对照组,观察组术后股四头肌肌无力发生率显著下降,且术后首次下床活动时间提前,术后住院时间缩短,差异均有统计学意义(P<0.05)。结论:IPB应用于THA可为患者提供良好的镇痛效果,且相比FICB,对髋部运动能力无不良影响,有利于术后快速恢复。

超声引导下髂筋膜间隙联合骶丛神经阻滞在老年髋部手术中的应用

目的探讨超声引导下髂筋膜间隙联合骶丛神经阻滞在老年髋部手术中的应用价值。方法选取2018年8月至2021年8月就诊于武汉中西医结合骨科医院178例行髋部手术的老年患者为研究对象。根据麻醉方法将患者分为联合阻滞组(行超声引导下髂筋膜间隙联合骶丛神经阻滞麻醉,n=92)及轻比重单侧腰麻(HUSA)组(n=86)。采用1∶1倾向性评分匹配法筛选出52对基线资料均衡可比的匹配序列。比较两组患者神经阻滞时间、疼痛程度、血流动力学、应激指标及并发症情况。采用SPSS 22.0统计软件进行数据分析。根据数据类型,组间比较分别采用t检验、重复测量方差分析或χ2检验。结果联合阻滞组多巴胺使用率及多巴胺平均用量均显著低于HUSA组(均P<0.05)。联合阻滞组感觉阻滞起效时间及完善时间均长于HUSA组,运动阻滞起效时间及完善时间均长于HUSA组,差异均有统计学意义(均P<0.05)。联合阻滞组摆侧卧位(T1)、术后12h及术后24h时点疼痛视觉模拟评分(VAS)分别低于HUSA组,切皮(T2)及术毕(T4)时点疼痛VAS分别高于HUSA组,差异均有统计学意义(均P<0.05)。联合阻滞组术后0~24 h及术后24~48 h吗啡用量分别小于HUSA组,差异均有统计学意义(均P<0.05)。联合阻滞组T1时点MAP小于HUSA组(P<0.05),手术开始30 min(T3)、T4时点大于HUSA组(P<0.05)。联合阻滞组T2、T3、T4时点MAP均较进入手术室(T0)时点下降(P<0.05);HUSA组T1时点MAP较T0时点显著升高(P<0.05),T2、T3、T4时点MAP均较T0时点显著下降(P<0.05)。联合阻滞组T1时点HR小于HUSA组(P<0.05)。HUSA组T1时点HR较T0显著升高(P<0.05)。联合阻滞组术后24h血糖与血浆皮质醇分别低于HUSA组,差异均有统计学意义(P<0.05)。联合阻滞组术后尿潴留、恶心呕吐、头晕头痛发生率分别低于HUSA组,差异均有统计学意义(P<0.05)。结论超声引导下髂筋膜间隙联合骶丛神经阻滞可维持术中血流动力学稳定、控制术后疼痛、减少应激反应和术后并发症。

超声引导下腹股沟韧带上髂筋膜阻滞联合喉罩全麻在老年患者大隐静脉曲张手术中的应用

目的探讨超声引导下腹股沟韧带上髂筋膜阻滞联合喉罩全身麻醉(全麻)在老年患者大隐静脉曲张手术中的应用价值。方法选取择期行单侧大隐静脉高位结扎点式剥脱联合激光闭合术的老年患者60例,随机分为A组(单纯喉罩全麻)和B组(超声引导下腹股沟韧带上髂筋膜阻滞联合喉罩全麻),每组30例。记录术中麻醉药物用量、血流动力学波动和喉罩拔除时间;评估术后静态和动态疼痛视觉模拟量表(VAS)评分、15项恢复质量(QoR-15)评分、简易智力状态检查(MMSE)评分以及不良反应情况,并进行比较。结果B组术后24 h QoR-15和MMSE评分均高于A组(P均<0.05);A组切皮时的平均动脉压和心率均高于B组(P均<0.05);B组术后5 min、30 min、6 h、12 h静态和动态疼痛VAS评分均低于A组(P均<0.05);B组丙泊酚用量、瑞芬太尼用量及喉罩拔除时间均低于A组,差异均有统计学意义(P均<0.05)。结论超声引导下腹股沟韧带上髂筋膜阻滞联合喉罩全麻可改善患者术后恢复质量和认知功能,减少麻醉药物用量,缩短拔管时间,增强血流动力学稳定性,减轻术后疼痛,从而促进快速康复。